While financial incentives influence physician behavior and moderately improve quality measures, non-incentivized providers targeted with other quality measure efforts have greater performance improvement, according to a recent study published by the JAMA Network.

A combination of interventions, IT advancements and close contact support are responsible for greatest improvements in quality measures, said Sean Gleeson, MD, medical director, Partners for Kids at Nationwide Children's Hospital and one of the study's authors.

"P4P is good, but it's not enough to make the greatest impact," he adds. "What's important is that all groups saw positive impacts. All physicians are growing in a positive direction."

Although the pay-for-performance model is decades old, there's been a steady increase of its use within state Medicaid programs, private health plans and internationally. Traditionally, P4P programs are initiated by payers, rather than physician-driven entities like ACOs.

"P4P provides incentives, but improvement can be difficult without further action," Gleeson said. There need to be interventions like improving EMRs to support clinical services and analytics for employee management.

Other ways to improve the program, he said, included harnessing big data to analyze patient information and base incentives on those improvements, and to look at patients with the greatest needs.

"We need a better system," he added, One that includes stratification to identify the types of patients most in need and, with that information, to make a greater impact. "We've realized on the most basic level that we're going to keep using P4P; it's worth it.”

The study also found ACOs should dive deeper into analytics to determine the best program implementations for performance improvements. ACOs are a critical part of transitioning into a P4P model to put more responsibility on decision makers, improve care outcomes and accept responsibility for patients. They must also recognize they're "able to get better outcomes as a group, rather than independently," he added.

The study examined three provider care physician groups: community physicians who received P4P incentives, non-incentivized community physicians and non-incentivized physicians employed at the hospital.

Nearly 3,000 physicians were studied from about 132 practices, using a differences-in-differences design, which measured previous years' performance (2010-2011) to the studied data set (2012-2013). The goal was to determine whether P4P service positively affected care outcomes.

Partners for Kids is a physician hospital organization and ACO based out of Columbus and is financially responsible for 330,000 Medicaid managed care children from 34 counties. PFK is contracted on behalf of its member physicians and Nationwide Children's Hospital.